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Risk assessments & personalized approaches to fall prevention among older adults

Risk assessments that gauge an individual’s risk of falling allow providers to personalize fall prevention interventions based on that individual’s needs. Such assessments are typically provided to older adults by health professionals such as registered nurses or physicians and can include a functional assessment, balance and gait assessments, and/or exercise assessments. Following assessment, individuals are provided multifactorial interventions designed to reduce their poersonal fall risk, which may include exercise (i.e., balance, strength, and endurance training), home or environmental modification, medication optimization, education, or vitamin D supplementation. Patients can also be referred to specialists such as physiotherapists for further care (). Falls can lead to long-term physical injuries, increased risk of early death, and psychological concerns such as fear of falling and loss of confidence (CDC-Falls, ).

Expected Beneficial Outcomes (Rated)

  • Reduced falls

Other Potential Beneficial Outcomes

  • Reduced injuries

Evidence of Effectiveness

There is strong evidence that individual risk assessments and personalized fall prevention interventions reduce the rate of falls among older adults in hospitals, especially those with longer lengths of stay, and among those in community settings (, ). Such interventions may also reduce the risk of falls among older hospital patients and appear to reduce fall-related injuries in nursing care facilities (). The combination of interventions varies by individual and by setting; additional evidence is needed to determine the most effective combination for each setting.

Impact on Disparities

No impact on disparities likely

Implementation Examples

As of July 2014, 11 states have laws that require funding for a variety of risk assessment and fall prevention activities in community, clinical, and nursing care settings. Some of these laws include provisions that incentivize primary care providers to integrate risk assessments and prevention activities into their practice (NCSL-Falls).

Implementation Resources

CDC-Falls - Centers for Disease Control and Prevention (CDC). Falls - older adults.

CDC-STEADI - Centers for Disease Control and Prevention (CDC). STEADI (Stopping Elderly Accidents, Deaths & Injuries) tools for health care providers and patients.

IHI-TCAB - Institute for Healthcare Improvement (IHI). Transforming Care at the Bedside how-to guide: Reducing patient injuries from falls.

NCOA-Falls prevention - National Council on Aging (NCOA). National falls prevention resource center.

Mayo Clinic-Falls - Mayo Clinic. Fall prevention: Simple tips to prevent falls.

Citations - Evidence

* Journal subscription may be required for access.

Cochrane-Cameron 2012* - Cameron ID, Gillespie LD, Robertson MC, et al. Interventions for preventing falls in older people in care facilities and hospitals: Review. The Cochrane Database of Systematic Reviews. 2012;(12):CD005465.

Cochrane-Gillespie 2012* - Gillespie LD, Robertson MC, Gillespie WJ, et al. Interventions for preventing falls in older people living in the community: Review. The Cochrane Database of Systematic Reviews. 2012;(9):CD007146.

Citations - Implementation Examples

* Journal subscription may be required for access.

NCSL-Falls - National Conference of State Legislatures (NCSL). Elderly falls prevention legislation and statutes.

Date Last Updated

Feb 3, 2016